Project Summary/Abstract After discharge from neonatal intensive care, a subset of preterm and full-term infants will have elevated risk for compromised development. An estimated 40-70% of these infants will have problematic feeding during the first 24 months. Because problematic feeding may escalate into a chronic feeding disorder, early symptom identification is critical. Linking early physiologic symptoms of problematic feeding with subsequent behavioral symptoms is needed to speed detection, enhance effective symptom management, and disrupt progression from problematic feeding to chronic feeding disorders. A lack of valid assessment that accounts for normal variation in feeding in children?s early development has impeded development of evidence to support a shift to earlier detection and targeted care. To address this problem, our team has developed a set of progressive, valid, reliable measures of symptoms of problematic feeding and eating skill development that can be used from birth through early childhood, with scoring systems that are standardized by age. Two parent-report measures of the child?s feeding environment complete the set. In the proposed study, we will use a concurrent explanatory mixed- methods longitudinal design to prospectively follow 285 infants at risk for feeding problems from discharge from neonatal intensive care through age 24 months. By concentrating assessments in the 1st year with follow-up in the 2nd year, we will study symptoms of problematic feeding across a critical period of development highly sensitive to adequate nutrition and with infants at highest risk for poor outcomes. Aim 1: Characterize children?s symptoms of problematic feeding and trajectories of symptoms from the time of NICU discharge through age 24 months. Aim 2: Determine the relationship of child biological function evident at discharge (neonatal biological risk, feeding skills, cardio-respiratory stability, gastro-intestinal function, autonomic nervous system regulation) and child sex with symptom characteristics and trajectories emerging across the next 24 months. Aim 3: Describe the child?s feeding environment (parent/family demographics; parent strategies to manage problematic feeding symptoms; receipt of feeding specialty services; feeding impact on the parent/family) and its relationship with problematic feeding symptoms from discharge through 24 months. Interviews with a sample subset will allow a more contextual understanding of the child?s feeding environment. Aim 4: Determine the relationship between symptoms of problematic feeding and child outcomes of the development of eating skills, growth, and neurodevelopment. By improving understanding of characteristics of early symptoms of problematic feeding during the period when feeding disorders are emerging, and through better understanding of the family dynamic related to feeding problem development, we can determine common biobehavioral pathways in children?s development of chronic feeding disorders, which will lay the groundwork for development of precision interventions in future research.